Medway & Millis February 2020

Page 10 Medway & Millis Local Town Pages www.localtownpages.com February 2020
Living Healthy
Glaucoma Treatment: SLT :10 Commonly Asked Questions
By Roger M. Kaldawy, M.D.,
Milford Franklin Eye Center
Lasers can be very useful in
treating many eye problems,
from helping patients eliminate
the need for glasses to cosmetic
procedures of the eyelids, and bladeless
cataract surgery to treatment
of glaucoma.
Glaucoma is a condition that
can damage our field of vision. It
affects us when the pressure inside
the eye is higher than what
the eye can tolerate. Glaucoma is
treatable with drops targeted at
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lowering the eye pressure. Laser
technology can also be used in a
focused beam of light to treat the
drainage angle of the eye in an
additional attempt to lower the
pressure. This surgery makes it
easier for fluid to flow out of the
front part of the eye, decreasing
pressure inside the eye. Selective
laser trabeculoplasty or SLT is
the name of the laser procedure
used to lower the pressure. SLT
has been in use for more than 25
years in the United States and
around the world.
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• Who is a candidate for SLT?
Patients who have primary or
secondary open-angle glaucoma
(the drainage system
in the front part of the eye is
open) and who need lowering
of their intraocular pressure
(IOP) are eligible for the procedure.
Your eye doctor will
make the final determination
if you are a candidate.
• How does it work? Laser energy
is applied to the drainage
tissue in the eye. This starts
a chemical and biological
change in the tissue that results
in better drainage of fluid
through the drain and out of
the eye. This eventually results
in lowering of IOP. It may take
1-3 months for the results to
appear.
• Why is it called Selective?
The type of laser used has
minimal heat energy absorption,
because it is only taken
up by selected pigmented tissue
in the eye. Sometimes it
is referred to as a “cold laser.”
Because of this, the procedure
produces less scar tissue and
has minimal pain.
• What are the risks? One key
aspect of SLT is a favorable
side effect profile, even when
compared with glaucoma
medications. Post-operative
inflammation is common, but
generally mild and treated with
observation or eye drops or an
oral non-steroidal anti-inflammatory
drug. There is an approximately
5% incidence of
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IOP elevation after laser, which
can be managed by glaucoma
medications and usually goes
away after 24 hours.
• How effective is it, and how
long does it last? SLT lowers
the IOP by about 30% when
used as initial therapy. This is
comparable to the IOP lowering
of the most powerful and
commonly used class of glaucoma
medication (prostaglandin
analogs). This effect may
be reduced if the patient is
already on glaucoma medications.
The effect will generally
last between 1-5 years, and in
some cases, longer than that.
If it does not last at least 6-12
months, it is usually not considered
successful.
• What happens if it wears off?
If SLT is effective at lowering
IOP, but this wears off over several
years, the procedure can
be repeated. Repeat treatments
may or may not lower IOP as
much as the first, and continued
repeat laser will eventually
not be effective. Some doctors
may elect to treat half of the
tissue on the first treatment,
then treat the second half at
a later date (this is not considered
repeat treatment, and is
completion of treatment). If
SLT is not initially successful,
repeat treatment is not likely to
be effective. Alternatively, glaucoma
medication can be used
if the effect wears off over time.
• What happens if it doesn’t
work? If SLT fails to lower
MILFORD - FRANKLIN
EYE CENTER
Roger M. Kaldawy, M.D. John F. Hatch, M.D.
Kameran A. Lashkari, M.D. Shazia S. Ahmed, M.D.
Michael R. Adams, O.D. Caroline Perriello Consigli, O.D.
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the IOP, then the glaucoma is
treated by other means, such as
additional medications or surgery.
The laser does not affect
the success of these other types
of treatment.
• What is the cost? Since the
procedure is an accepted
glaucoma treatment, and is
FDA approved, it is covered
by Medicare and medical insurance.
The cost for an uninsured
individual or with an
insurance co-pay, will vary.
• Will I still need to use glaucoma
medications? Some
patients can be controlled with
just laser treatment. Others require
additional IOP lowering
and may therefore need to use
glaucoma medication as well.
Think of the SLT as equivalent
to one glaucoma medication.
Just as some patients
will require more than one
glaucoma medication to control
their IOP, some may also
require laser plus one or more
glaucoma medications. It is important
to remember that SLT
is not a cure for glaucoma, just
as medication and surgery are
not. Whatever method is used
to treat glaucoma, appropriate
follow up and testing with your
eye care professional is critical.
• What are the alternative
laser treatments? Other similar
procedures are argon laser
trabeculoplasty (ALT) and
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